Feds Take Over Whistleblower Case Against UnitedHealth Group

The insurance giant could face a penalty of more than $1 billion.

The United States Department of Justice is joining a whistleblower lawsuit against Minnetonka-based UnitedHealth Group in which the insurer is accused of receiving overpayments from the government—potentially in excess of $1 billion—for artificially inflating patient risk scores tied to Medicare Advantage plans.

California resident James Swoben first filed a suit making these claims against UnitedHealth Group, the parent company of UnitedHealthcare, in 2009. His suit is joining that of Benjamin Poehling, a former UnitedHealth executive, who filed action against the insurance company in 2011. Poehling’s case was just unsealed this month by a federal judge.

The government announced its plan to consolidate the two cases on Monday. Its intervention will mean the stakes are much higher for UnitedHealth as damages could top $1 billion, according to NPR.

In the lawsuit, the insurance company is said to have given patient diagnosis information to Medicare Advantage in order to receive payments from the government. As an alternative to the government-run Medicare plan, Medicare Advantage is a private health plan that enrolls over 18 million elderly and disabled patients and costs taxpayers more than $150 billion a year.

Upon submitting a patient’s diagnosis, UnitedHealth allegedly later added more diagnosis codes to its submission, which in turn increased the payments it received.

In a statement, UnitedHealth denied the allegations it faced. “Litigating against Medicare Advantage plans to create new rules through courts will not fix widely acknowledged government policy shortcomings or help Medicare Advantage members and is wrong,” the company said.

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